Distinctive lesions of brain MRI between MOG-antibody-associated and AQP4-antibody-associated diseases
Yuki Matsumoto, Tatsuro Misu, Shunji Mugikura, Yoshiki Takai, Shuhei Nishiyama, Hiroshi Kuroda, Toshiyuki Takahashi, Juichi Fujimori, Ichiro Nakashima, Kazuo Fujihara, Masashi Aoki
Abstract
The autoantibody against myelin oligodendrocyte glycoprotein (MOG) is present in patients with several inflammatory diseases such as neuromyelitis optica spectrum disorder (NMOSD), acute disseminated encephalomyelitis (ADEM), optic neuritis and transverse myelitis. Differential diagnosis is difficult because of overlapping clinical and radiological features.1 In adult patients with MOG-Ab-associated disease (MOGAD), the highest occurrence of lesions was in the thalamus and pons in MOGADOR study,1 but the other study showed that MOGAD lesion was more often found in subcortical white matter and the internal capsule, but the pontine lesion was not revealed as distinct.2 In paediatric patients, the cerebellar peduncle was dominant in MOGAD, but there were no statistically significant differences in the pons, thalamus and cortical lesions.3 Such discrepancies might suggest a wide diversity in lesion configuration and extraction, range of diseases and various age of disease onsets. In our large-scale study, we divided the brain regions of interest into 21 defined sections and analysed lesion distributions for both MOGAD and NMOSD. ### Patients Inclusion criteria is as followed: (1) CNS (central nervous system) demyelinating disease referred to the Department of Neurology at Tohoku University in 2018, (2) aquaporin-4 or MOG antibody positivity by in-house cell-based assay, (3) the availability of brain MRI data, and (4) the detected MRI lesions taken within 1 month in clinically acute stage. We finally enrolled 134 patients with MOGAD and 70 patients with NMOSD (online supplement file - Patients). ### Supplementary data [jnnp-2020-324818supp001.pdf] ### Brain MRI analysis Clinical brain MRI scans, including T2-weighted and fluid-attenuated inversion recovery sequences, had been acquired using 3.0/1.5 T scanners. An independent neurologist and a blinded neuroradiologist (YM and SM, respectively) performed MRI assessments by brain lesion division (21 areas; online supplement file - MRI). In cases of disagreement, final decisions were based on a consensus between the two evaluators. To better visualise the prevalence and …